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State of Colilornia—Environmental Protection Agency <br />Form Approved OMB No. 2050-0039 (Expires 9.30.991 <br />Please print or type. Form designed for use on elite 112 pitch) <br />As. <br />V <br />m <br />N <br />e <br />O <br />� O <br />O <br />K <br />w <br />Z <br />Z <br />U <br />w <br />—Z <br />See Instructions on back of a 6. Department of Toxic Substances Control <br />a./ Sacramento, California <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (A/971 ccNcpTn rcv_:Nc <br />EPA 8700-22 r <br />UNIFORM HAZARDOUS <br />1. Generator's US EPA ID No. <br />Manifest Document No. <br />2. Page 1 <br />InFormalion in the shaded areas <br />is nal required by Federal low. <br />WASTE MANIFEST <br />( i 1 , ; <br />of 1 <br />3 Generators Name and Mailing Address <br />A. State Manifest Document Number <br />C +t'HIPII R; fIOVANNON1 <br />��++ <br />{{��O'F.i:C;HIIVT, <br />J <br />e <br />S1 <br />r <br />,: NDF'fHF;I D`3F CT., ANT IOC FI. CA 9.1509 <br />B. State Generator's to <br />dGenerator s Phone ( r --1f- 774-20 58 <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C. State Transporter', ID <br />PIDF: CAL, OIL_ C AD 9 >s:_ <br />4 17 5` - <br />D. Transporter', Phone <br />"209.' 66-7-6692 <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Transporter's ID - <br />F. Transporter', Phone <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />"I"li-!-'I1-I..E:'lr•t. INC'. <br />G. State <br />H.. Facility' y Ph one <br />11. US DOT Description (including Proper Ski Name, Hazard Class, and ID Number <br />P I'" 8 f �'"8 I <br />Containers <br />13. Tocol <br />Quantity <br />ld. Unit <br />WI/Vol <br />I. Waste Number <br />N. <br />No. <br />Type <br />G <br />Llfi TI Ij;- :i <br />1 <br />Q O <br />i-1 <br />EPA/Other <br />E <br />I N <br />Is. <br />sore <br />E <br />EPA/Other <br />R <br />TC. <br />State <br />. <br />Q <br />EPA/Other <br />R <br />d. <br />State <br />EPA/Other <br />J. Additional Descriptions for Moteriols Listed Above <br />K. Handling Codes for Wastes <br />Listed Above - <br />a <br />b. <br />TANK EOTTOM 14ASTE <br />iAdSATF <br />C, <br />d. <br />15. Special Handling Instructions and Addifonol Information <br />e�PFF:r,c•hII;.IF ppr,,r-rTl','E. t1Li_7H.Tr.it7- <br />tis; ,_.T,! <br />,11... 9: q,15" <br />_ ,-a cl,171f:Fr F:i <br />16. GENERATORS CERTIFICATION: I hereby declare that the contents of this constg em are fully and accurotely described above by proper shipping name and are classified, pocked. <br />marked, and labeled, ad are in all respects in proper condition For tronsport by highway according to applicoble international and notionol government regulations. <br />n <br />If I am a large quontiq generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economicallyY <br />and that live ,elected the practimble method oh treatment, storage, or disposal currently mailable to me which minimizes the present and future threat to human health <br />practicable <br />and the environment; OR, if I am a smolt quantity generator, I have made o good faith effort <br />to minimize my waste generation and select the best waste management method that is <br />available to me and that I can afford. <br />I <br />Printed/TypeNom <br />d a <br />Signature <br />Month Day Year <br />- _ :�a��091z <br />171 <br />1 <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />R <br />A <br />Printed/Typed Nome Signature <br />Month Doy ear <br />N <br />P.I C 1=;11IC'rT <br />/Vj 7 <br />P,. <br />1c <br />a <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />R <br />F <br />Printed/Typed Nome <br />Signature <br />Month Day Year <br />E <br />R <br />' <br />19. Di ... eponq Indication Space <br />F <br />A <br />C <br />I <br />L <br />20. Facility Owner or O rotor CernFcation of receipt of hazardous materials covered by thi, manifest except as noted in Item 19. <br />T <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />Y <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (A/971 ccNcpTn rcv_:Nc <br />EPA 8700-22 r <br />